Method of treatment with coadministration of aspirin and prasugrel

ABSTRACT

A method for the prevention of diseases caused by thrombus or embolus. The method is to separately administer 2-acetoxy-5-(α-cyclopropylcarbonyl-2-fluorobenzyl)-4,5,6,7-tetrahydrothieno[3,2-c]pyridine or a pharmaceutically acceptable salt thereof, and aspirin, in their pharmacologically effective amounts, to a warm-blooded animal.

This is a Divisional Application of application U.S. Ser. No. 10/600,266 filed Jun. 20, 2003, pending, which is a Continuation Application of International Application No. PCT/JP01/11201 filed Dec. 20, 2001, which is incorporated herein by reference in its entirety.

BACKGROUND OF THE INVENTION

This invention relates to pharmaceutical compositions containing 2-acetoxy-5-(α-cyclopropylcarbonyl-2-fluorobenzyl)-4,5,6,7-tetrahydrothieno[3,2-c]pyridine (Prasugrel) or a pharmaceutically acceptable salt thereof, and aspirin, as active ingredients [particularly pharmaceutical compositions for prevention or treatment (particularly for treatment) of diseases caused by thrombus or embolus]; to the use of 2-acetoxy-5-(α-cyclopropylcarbonyl-2-fluorobenzyl)-4,5,6,7-tetrahydrothieno[3,2-c]pyridine or a pharmaceutically acceptable salt thereof and aspirin for the manufacture of pharmaceutical compositions for prevention or treatment (particularly for treatment) of diseases caused by thrombus or embolus; and to methods for the prevention or treatment (particularly to methods for the treatment) of diseases caused by thrombus or embolus by administration of an effective amount of 2-acetoxy-5-(α-cyclopropylcarbonyl-2-fluorobenzyl)-4,5,6,7-tetrahydrothieno[3,2-c]pyridine or a pharmaceutically acceptable salt thereof and aspirin to warm-blooded animals (particularly humans).

2-Acetoxy-5-(α-cyclopropylcarbonyl-2-fluorobenzyl)-4,5,6,7-tetrahydrothieno[3,2-c]pyridine has been described in the Japanese Patent Application Publication No. Hei 6-41139, and possesses potent inhibitory activity against platelet aggregation. Furthermore, aspirin is well known to have an inhibiting activity against platelet aggregation, although the activity is low. However, pharmaceutical compositions containing both compounds have not been known.

BRIEF DESCRIPTION OF THE INVENTION

The present inventors have studied therapeutic agents with low toxicity that exert inhibitory activity against platelet aggregation and have found that the problems described above are solved by using pharmaceutical compositions comprising 2-acetoxy-5-(α-cyclopropylcarbonyl-2-fluorobenzyl)-4,5,6,7-tetrahydrothieno[3,2-c]pyridine or a pharmaceutically acceptable salt thereof and aspirin.

DETAILED DESCRIPTION OF THE INVENTION

The present invention provides pharmaceutical compositions containing 2-acetoxy-5-(α-cyclopropylcarbonyl-2-fluorobenzyl)-4,5,6,7-tetrahydrothieno[3,2-c]pyridine or a pharmaceutically acceptable salt thereof and aspirin as active ingredients [particularly pharmaceutical compositions for prevention or treatment (particularly for treatment) of diseases caused by thrombus or embolus]; the use of 2-acetoxy-5-(α-cyclopropylcarbonyl-2-fluorobenzyl)-4,5,6,7-tetrahydrothieno[3,2-c]pyridine or a pharmaceutically acceptable salt thereof, and aspirin, for the manufacture of pharmaceutical compositions [particularly pharmaceutical compositions for prevention or treatment (particularly for treatment) of diseases caused by thrombus or embolus]; and methods for the prevention or treatment (particularly methods for treatment) of diseases caused by thrombus or embolus by administration of an effective amount of 2-acetoxy-5-(α-cyclopropylcarbonyl-2-fluorobenzyl)-4,5,6,7-tetrahydrothieno[3,2-c]pyridine or a pharmaceutically acceptable salt thereof, and aspirin, to warm-blooded animals (particularly humans), simultaneously or sequentially.

2-Acetoxy-5-(α-cyclopropylcarbonyl-2-fluorobenzyl)-4,5,6,7-tetrahydrothieno[3,2-c]pyridine, and pharmaceutically acceptable salts thereof, which is one of the active ingredients of the present invention, is a known compound. For instance, the compound has already been described in Japanese Patent Application Publication No. Hei 6-41139 and Japanese Patent Application Publication No. 2002-145882 (priority: Japanese Patent Application No. 2000-205539, and Japanese Patent Application No. 2000-266780). The chemical structure is described below.

The pharmaceutically acceptable salts of 2-acetoxy-5-(α-cyclopropylcarbonyl-2-fluorobenzyl)-4,5,6,7-tetrahydrothieno[3,2-c]pyridine may be, for example, hydrohalogenic acid salts such as hydrofluoride, hydrochloride, hydrobromide or hydroiodide; nitrate; perchlorate; sulfate; phosphate; C₁-C₄ alkanesulfonates optionally substituted by halogens such as methanesulfonate, trifluoromethanesulfonate, ethanesulfonate; C₆-C₁₀ arylsulfonates optionally substituted by C₁-C₄ alkyl groups such as benzenesulfonate or p-toluenesulfonate; C₁-C₆ aliphatic acid salts such as acetate, malate, fumarate, succinate, citrate, tartarate, oxalate or maleate; amino acid salts such as glycine salt, lysine salt, arginine salt, ornitine salt, glutamic acid salt or aspartic acid salt; and the preferred compounds are hydrohalogenates or C₁-C₆ aliphatic acid salts; and more preferred compounds are the hydrochloride or the maleate.

When one of the active ingredients of the present invention, 2-acetoxy-5-(α-cyclopropylcarbonyl-2-fluorobenzyl)-4,5,6,7-tetrahydrothieno[3,2-c]pyridine or a pharmaceutically acceptable salt thereof, is allowed to stand so that it is open to the atmosphere, it may become hydrated by absorption of water or adsorption of water. Such hydrated compounds are included in the present invention.

Further, one of the active ingredients of the present invention, 2-acetoxy-5-(α-cyclopropylcarbonyl-2-fluorobenzyl) -4,5,6,7-tetrahydrothieno[3,2-c]pyridine or a pharmaceutically acceptable salt thereof, may absorb some kinds of organic solvents and may form solvates in some cases, and these solvates are also included in the present invention.

Furthermore, since 2-acetoxy-5-(α-cyclopropylcarbonyl-2-fluorobenzyl)-4,5,6,7-tetrahydrothieno[3,2-c]pyridine has an asymmetric carbon atom, optical isomers exist based on the asymmetric carbon atom. These optical isomers are also included in the present invention.

The other active ingredient, aspirin, is a well-known compound, as an analgesic antipyretic.

The pharmaceutical compositions of the present invention (particularly pharmaceutical compositions for the prevention or treatment of diseases caused by thrombus or embolus) which contain 2-acetoxy-5-(α-cyclopropylcarbonyl-2-fluorobenzyl)-4,5,6,7-tetrahydrothieno[3,2-c]pyridine or a pharmaceutically acceptable salt thereof, and aspirin, as active ingredients, possess excellent inhibitory activity against platelet aggregation and thrombogenesis with short onset latency and low toxicity. Thus the pharmaceutical compositions of the present invention are useful as preventative or therapeutic agents (particularly as therapeutic agents) against diseases caused by thrombus or embolus, for example, diseases induced by platelet aggregation, including stable or unstable angina pectoris and so forth; cardiovascular or cerebrovascular disorders, e.g., thromboembolism, associated with atherosclerosis or diabetes mellitus, such as unstable angina pectoris, cerebral ischemic insult or restenosis due to angioplasty, endarterectomy or stent therapy; or thromboembolism caused by thromboembolization such as recurrent embolism after degradation of the original thrombus, embolism, ischemia-induced dementia, peripheral arteriopathy, thromboembolization associated with hemodialysis or atrial fibrillation, or thromboembolization in the vascular prosthesis, or in the bypass between the aorta and the coronary artery. Furthermore, the therapeutic agent of the present invention is administered to warm-blooded animals (particularly humans).

According to the present invention, the use in combination of 2-acetoxy-5-(α-cyclopropylcarbonyl-2-fluorobenzyl)-4,5,6,7-tetrahydrothieno[3,2-c]pyridine or a pharmaceutically acceptable salt thereof, and aspirin, results in more potent effectiveness than the use of each component alone. Furthermore, plasma levels of these agents do not have to be maintained at a certain level and higher during the same period, in order to produce their effects. It is believed that these 2 agents reach the receptors, at which they act in vivo, and turn on switches at the receptors to induce the effects. Even though the plasma level of one component of the pharmaceutical composition is too low to induce the effects with increasing time after the agent was administered, the switches at the receptors have already been turned on. Thus the preventative or therapeutic efficacy of the agent is expected by inhibiting thrombogenesis or embolization.

Therefore, when the other component of the pharmaceutical composition is administered later, the therapeutic effect of the compound administered later is expected to add to the therapeutic effects of the previously administered component. However, it is convenient clinically that both components are administered at the same time. Thus 2-acetoxy-5-(α-cyclopropylcarbonyl-2-fluorobenzyl)-4,5,6,7-tetrahydrothieno[3,2-c]pyridine or a pharmaceutically acceptable salt thereof and aspirin are simultaneously administered as a combination drug. In the case that both agents cannot be mixed technically, each component can be administered separately. Moreover, as described previously, since each component produces significant effects as a single form, each component can be sequentially administered at appropriate intervals. The maximum intervals between administration of each of the two components that can be accepted to elicit significant effects could be confirmed by clinical trials or animal studies.

The route for administration of 2-acetoxy-5-(α-cyclopropylcarbonyl-2-fluorobenzyl)-4,5,6,7-tetrahydrothieno[3,2-c]pyridine or a pharmaceutically acceptable salt thereof, and aspirin, which is employed in the present invention, is generally the oral route. However, other routes, for example, intravenous administration, can be used. Thus, the 2 components can be prepared respectively as separate formulations, or can be mixed physically to form a single formulation for administration. The single formulations of the mixed components are, for example, powders, granules, tablets, capsules and so forth, and can be prepared by regular formulation techniques, as described below.

These formulations are prepared by conventional methods by using excipients (organic excipients, for example, sugar derivatives such as lactose, sucrose, glucose, mannitol or sorbitol; starch derivatives such as corn starch, potato starch, α-starch or dextrin; cellulose derivatives such as crystalline cellulose; gum arabic; dextran; or pullulan; and inorganic excipients, for example, silicate derivatives such as light silicic acid anhydride, synthetic aluminum silicate, calcium silicate or magnesium aluminate metasilicate; phosphate derivatives such as calcium hydrogenphosphate; carbonates such as calcium carbonate; or sulfates such as calcium sulfate), lubricants (for example, stearic acid; metal stearate derivatives such as calcium stearate or magnesium stearate; talc; waxes such as beeswax or spermaceti; boric acid; adipic acid; sulfate derivatives such as sodium sulfate; glycol; fumaric acid; sodium benzoate; DL-leucine; lauryl sulfate derivatives such as sodium lauryl sulfate or magnesium lauryl sulfate; silicic acid derivatives such as silicic acid anhydride or silicic acid hydrate; and starch derivatives described above), binders (for example, hydroxypropyl cellulose, hydroxypropylmethylcellulose, poly(vinylpyrrolidone), polyethylene glycol and similar compounds described in the above excipients), disintegrators (for example, cellulose derivatives such as low substituted hydroxypropylcellulose, carboxymethylcellulose, calcium carboxymethylcellulose, internally cross-linked sodium carboxymethylcellulose; chemically modified starch/cellulose derivatives such as carboxymethylstarch, sodium carboxymethylstarch; cross-linked polyvinylpyrrolidone; or starch derivatives described above), emulsifiers (for example, colloidal clays such as bentonite or veegum; metal hydroxides such as magnesium hydroxide or aluminum hydroxide; anionic surfactants such as sodium lauryl sulfate or calcium stearate; cationic surfactants such as benzalkonium chloride; or nonionic surfactants such as polyoxyethylene allyl ether, polyoxyethylenesorbitan ester of fatty acids or sucrose ester of fatty acids), stabilizers (for example, parahydroxybenzoates such as methylparaben or propylparaben; alcohols such as chlorobutanol, benzyl alcohol or phenylethyl alcohol; benzalkonium chlorides; phenol derivatives such as phenol or cresol; thimerosal; dehydroacetic acid; or sorbic acid), corrigents (for example, sweetening, souring and flavoring agents all of which are conventionally used), and diluents.

The dose and the dose ratio of 2-acetoxy-5-(α-cyclopropylcarbonyl-2-fluorobenzyl)-4,5,6,7-tetrahydrothieno[3,2-c]pyridine or pharmaceutically acceptable salt thereof, and aspirin, can be widely altered based on several factors such as activity of each compound, and the symptoms, age and body weight of the patients.

Generally, the lower limit of the oral dose (mg drug dose/time) is 0.1 mg (preferably, 1 mg) per time, while the upper limit is 1,000 mg (preferably, 500 mg) per time. The lower and upper limits of intravenous injection are 0.01 mg (preferably, 0.1 mg) and 500 mg (preferably, 250 mg), respectively. They are administered to the adult from 1 to 7 times a day based on the symptoms of the patient, simultaneously or sequentially.

Generally, the dose ratio of 2-acetoxy-5-(α-cyclopropylcarbonyl-2-fluorobenzyl)-4,5,6,7-tetrahydrothieno[3,2-c]pyridine or pharmaceutically acceptable salt thereof, and aspirin, is from 1:500 to 500:1 as their weight ratio.

EXAMPLES

The present invention is described in detail with examples and formulations in the following. However, the claim of the present invention is not restricted to the following description.

Example 1 Inhibitory Activity against Thrombogenesis

As the test animals, male Sprague Dawley rats of 7 weeks old were purchased from SLC Japan and 6 rats per group were used.

2-Acetoxy-5-(α-cyclopropylcarbonyl-2-fluorobenzyl)-4,5,6,7-tetrahydrothieno[3,2-c]pyridine was synthesized according to the method described in the Specification of Japanese Patent Application Publication No. Hei 6-41139 and was used, while aspirin was purchased from Sigma Chemical Co. and was used. Both compounds were suspended in 5% (w/v) gum arabic solution, and were diluted so as to be 1 ml/kg of administration volume and were orally administered.

The inhibitory activities of the compounds against thrombogenesis or thrombus formation were evaluated in the modified arterio-venous shunt thrombosis model in rats, which was described by Umetsu et al. [Thromb. Haemost., 39, 74-83 (1978)].

The shunt tube was prepared as follows; i.e., both sides of a medical silicon tube of 12 cm length [inner diameter: 1.5 mm, outer diameter: 2.5 mm, purchased from KANEKA Medix Co., Ltd] were connected each to a polyethylene tube of 7 cm length [inner diameter: 0.5 mm, outer diameter: 1.0 mm, purchased from Natsume Seisakusho Co., Ltd.] covered with silicon via a medical silicon tube of 0.7 cm length [inner diameter: 1.0 mm, outer diameter: 1.5 mm, KANEKA Medix Co., Ltd] as connector. A surgical suture of 10 cm length was placed in the silicon tube of 12 cm length.

The animal was anesthetized with an intraperitoneal injection of 40 mg/kg of pentobarbital sodium (purchased from Abbott Laboratories Inc.), and the jugular of one side and the carotid of the other side were exposed. The arteriovenous shunt was made by cannulation of a shunt tube filled with heparin solution [30 units/kg, purchased from Fuso Pharmaceutical Co., Ltd] into the carotid and the jugular which had been previously exposed.

The test compounds were orally administered and the blood was started to circulate into the shunt area two hours after-the administration. Thirty minutes after the circulation was started, the shunt tube was removed, and the thrombus adsorbed on the surgical suture was weighed. The results are shown in Table 1. The results in the table are expressed as the average weight±SE (n=6). TABLE 1 Compounds Compound A Aspirin Thrombus Weight Inhibition Rate (mg/kg) (mg/kg) (mg) (%) 0 0 52.3 ± 1.2 — 0 10 46.6 ± 2.8 12.3 ± 4.4 0.3 0 43.5 ± 2.1 17.0 ± 4.1 0.6 0 37.5 ± 2.1 28.3 ± 4.0 0.3 10 30.5 ± 3.5 41.8 ± 6.6 0.6 10 23.2 ± 3.8 55.7 ± 7.2 Compound A: 2-Acetoxy-5-(α-cyclopropylcarbonyl-2-fluorobenzyl)-4,5,6,7-tetrahydrothieno[3,2-c]pyridine

(Formulation 1) Tablets Compound A 10.0 mg Aspirin 12.5 mg Lactose 175.5 mg Corn starch 50.0 mg Magnesium stearate 2.0 mg Total 250 mg

The powders in the formula described in the above table are mixed, compressed with a tableting machine and formulated as a tablet containing 250 mg in total. The tablet can be coated with film or sugar, when necessary. 

1. A method for the prevention of diseases caused by thrombus or embolus, comprising separately administering 2-acetoxy-5-(α-cyclopropylcarbonyl-2-fluorobenzyl)-4,5,6,7-tetrahydrothieno[3,2-c]pyridine or a pharmaceutically acceptable salt thereof, and aspirin, in their pharmacologically effective amounts, to a warm-blooded animal.
 2. A method according to claim 1, in which the pharmaceutically acceptable salt is the hydrochloride or maleate.
 3. A method according to claim 1 or claim 2, in which the warm-blooded animal is a human.
 4. A method for the treatment of diseases caused by thrombus or embolus, comprising separately administering 2-acetoxy-5-(α-cyclopropylcarbonyl-2-fluorobenzyl)-4,5,6,7-tetrahydrothieno[3,2-c]pyridine or a pharmaceutically acceptable salt thereof, and aspirin, in their pharmacologically effective amounts, to a warm-blooded animal.
 5. A method according to claim 1 or 4, wherein diseases caused by thrombus or embolus are cardiovascular or cerebrovascular disorders.
 6. A method according to claim 1 or 4, wherein diseases caused by thrombus or embolus are thromboembolism, associated with atherosclerosis or diabetes mellitus.
 7. A method according to claim 1 or 4, wherein diseases caused by thrombus or embolus are unstable angina pectoris, cerebral ischemic insult or restenosis due to angioplasty, endarterectomy or stent therapy.
 8. A method according to claim 4, in which the pharmaceutically acceptable salt is the hydrochloride or maleate.
 9. A method according to claim 4 or claim 8, in which the warm-blooded animal is a human.
 10. A method for the treatment of a patient undergoing stenting, angioplasty, and/or to prevent restenosis comprising separately administering 2-acetoxy-5-(α-cyclopropylcarbonyl-2-fluorobenzyl)-4,5,6,7-tetrahydrothieno[3,2-c]pyridine or a pharmaceutically acceptable salt thereof, and aspirin, to a warm-blooded animal.
 11. A method according to claim 10, in which the pharmaceutically acceptable salt is the hydrochloride or maleate.
 12. A method according to claim 10 or claim 11, in which the warm-blooded animal is a human. 